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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Case Report

Delayed Multiple Non-ischemic Cerebral Enhanced Lesions After Endovascular Therapy For Left Internal Carotid Aneurysm: A Case Report

Author(s): Yanli Cai, Lin Huang, Jianqiang Hao, Fei Xie*, Tianjin Ling and Seidu A. Richard

Volume 17, Issue 8, 2021

Published on: 22 January, 2021

Page: [1031 - 1035] Pages: 5

DOI: 10.2174/1573405617666210122085247

Price: $65

Abstract

Introduction: Endovascular therapy (EVT) for intracranial arterial aneurysms is depicted with several complications. Very recently, delayed non-ischemic cerebral enhanced (NICE) lesions have been identified as a rare complication associated with EVT. This complication always stands a higher chance of being missed in asymptomatic patients. We report a case of multiple NICE lesions in a known chronic hepatitis B infection and chronic gastritis patient with left internal carotid aneurysm (ICA) treated with detachable coils.

Case Presentation: A 52 years old female with left ICA was treated with detachable coils via the endovascular route. Three weeks after the operation, she presented with numbness of her right limbs which was persistent and waked her up from sleep each night. She admitted skin allergies after wearing metals except for gold and silver since childhood. MRI revealed multiple abnormal lesions in the left temporal lobe, hippocampus, insula, and parietal lobe and some perifocal edema which were consistent with the diagnosis of delayed NICE lesions.

Conclusion: It is very important to report the occurrences of these lesions in literature because of their allergic origin. We advocate that allergy to metals especially those used in coating endovascular equipment should be evaluated before every EVT for intracranial aneurysms.

Keywords: Allergy, aneurysm, endovascular, MRI, NICE lesions, therapy.

Graphical Abstract

[1]
Shotar E, Law-Ye B, Baronnet-Chauvet F, et al. Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature. Neuroradiology 2016; 58(9): 877-85.
[http://dx.doi.org/10.1007/s00234-016-1699-5] [PMID: 27216205]
[2]
Ulus S, Yakupoğlu A, Kararslan E, Işlak C, Siva A, Koçer N. Reversible intracranial parenchymal changes in MRI after MCA aneurysm treatment with stent-assisted coiling technique; possible nickel allergy. Neuroradiology 2012; 54(8): 897-9.
[http://dx.doi.org/10.1007/s00234-012-1048-2] [PMID: 22653481]
[3]
Skolarus LE, Gemmete JJ, Braley T, Morgenstern LB, Pandey A. Abnormal white matter changes after cerebral aneurysm treatment with polyglycolic-polylactic acid coils. World Neurosurg 2010; 74(6): 640-4.
[http://dx.doi.org/10.1016/j.wneu.2010.03.026] [PMID: 21492633]
[4]
Shapiro M, Ollenschleger MD, Baccin C, et al. Foreign body emboli following cerebrovascular interventions: clinical, radiographic, and histopathologic features. AJNR Am J Neuroradiol 2015; 36(11): 2121-6.
[http://dx.doi.org/10.3174/ajnr.A4415] [PMID: 26294650]
[5]
Lobotesis K, Mahady K, Ganesalingam J, et al. Coiling-associated delayed cerebral hypersensitivity: Is nickel the link? Neurology 2015; 84(1): 97-9.
[http://dx.doi.org/10.1212/WNL.0000000000001106] [PMID: 25428692]
[6]
Fealey ME, Edwards WD, Giannini C, Piepgras DG, Cloft H, Rihal CS. Complications of endovascular polymers associated with vascular introducer sheaths and metallic coils in 3 patients, with literature review. Am J Surg Pathol 2008; 32(9): 1310-6.
[http://dx.doi.org/10.1097/PAS.0b013e318165582a] [PMID: 18636015]
[7]
Cruz JP, Marotta T, O’Kelly C, et al. Enhancing brain lesions after endovascular treatment of aneurysms. AJNR Am J Neuroradiol 2014; 35(10): 1954-8.
[http://dx.doi.org/10.3174/ajnr.A3976] [PMID: 24874528]
[8]
Geisbush TR, Marks MP, Heit JJ. Cerebral foreign body reaction due to hydrophilic polymer embolization following aneurysm treatment by pipeline flow diversion device. Interv Neuroradiol 2019; 25(4): 447-53.
[http://dx.doi.org/10.1177/1591019919830767] [PMID: 30922199]
[9]
Shannon P, Billbao JM, Marotta T, Terbrugge K. Inadvertent foreign body embolization in diagnostic and therapeutic cerebral angiography. AJNR Am J Neuroradiol 2006; 27(2): 278-82.
[PMID: 16484392]
[10]
Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet 1999; 354(9190): 1594-7.
[http://dx.doi.org/10.1016/S0140-6736(99)07083-X] [PMID: 10560674]
[11]
Saigal G, Bhatia R, Bhatia S, Wakhloo AK. MR findings of cortical blindness following cerebral angiography: is this entity related to posterior reversible leukoencephalopathy? AJNR Am J Neuroradiol 2004; 25(2): 252-6.
[PMID: 14970026]
[12]
Kitamura T, Oishi H, Fujii T, et al. Delayed Complications Due to Polymer Coating Embolism after Endovascular Treatment. NMC Case Rep J 2019; 7(1): 5-10.
[13]
Molyneux AJ, Kerr RS, Birks J, et al. ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 8(5): 427-33.
[http://dx.doi.org/10.1016/S1474-4422(09)70080-8] [PMID: 19329361]
[14]
Spetzler RF, McDougall CG, Albuquerque FC, et al. The barrow ruptured aneurysm trial: 3-year results. J Neurosurg 2013; 119(1): 146-57.
[http://dx.doi.org/10.3171/2013.3.JNS12683] [PMID: 23621600]
[15]
Spetzler RF, McDougall CG, Zabramski JM, et al. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg 2015; 123(3): 609-17.
[http://dx.doi.org/10.3171/2014.9.JNS141749] [PMID: 26115467]
[16]
Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke 2013; 44(7): 2046-54.
[http://dx.doi.org/10.1161/STROKEAHA.113.000733] [PMID: 23798560]
[17]
Pierot L, Cognard C, Spelle L, Moret J. Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 2012; 33(1): 12-5.
[http://dx.doi.org/10.3174/ajnr.A2403] [PMID: 21349960]
[18]
Jeswani S, Alexander MJ. Nickel allergy: a reason for concern? J Neurointerv Surg 2011; 3(1): 2-4.
[http://dx.doi.org/10.1136/jnis.2010.003657] [PMID: 21990778]
[19]
Mehta RI, Mehta RI. Polymer-induced central nervous system complications following vascular procedures: spectrum of iatrogenic injuries and review of outcomes. Hum Pathol 2016; 53: 178-90.
[http://dx.doi.org/10.1016/j.humpath.2016.01.018] [PMID: 27072640]
[20]
Lorentzen AO, Nome T, Bakke SJ, Scheie D, Stenset V, Aamodt AH. Cerebral foreign body reaction after carotid aneurysm stenting. Interv Neuroradiol 2016; 22(1): 53-7.
[http://dx.doi.org/10.1177/1591019915609171] [PMID: 26510943]
[21]
Hu YC, Deshmukh VR, Albuquerque FC, et al. Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the Pipeline Embolization Device. J Neurosurg 2014; 120(2): 365-74.
[http://dx.doi.org/10.3171/2013.11.JNS131599] [PMID: 24320006]
[22]
Deguchi K, Kawahara Y, Deguchi S, et al. A patient develops transient unique cerebral and cerebellar lesions after unruptured aneurysm coiling. BMC Neurol 2015; 15: 49.
[http://dx.doi.org/10.1186/s12883-015-0303-7] [PMID: 25884179]
[23]
Meiers C, Abebe Y, Alberto NM, et al. Cerebral granulomatous inflammation secondary to hydrophilic polymer embolization following thrombectomy. Am J Case Rep 2017; 18: 507-11.
[http://dx.doi.org/10.12659/AJCR.902598] [PMID: 28479590]

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